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Does Your Practice Have a Compliance Officer or Compliance Committee?

Team of Doctors(October 29, 2015): Last month we discussed why having a functioning, effective compliance program is important. If done correctly, a compliance program that is functional, effective, and well-documented is as important as your medical malpractice liability insurance. Indeed, the Affordable Care Act now requires compliance programs and many private payers now explicitly require compliance programs in their physician contracts.

But compliance programs don’t just materialize out of thin air. I have yet to be able to wave a wand or say an incantation that will bring a compliance program into being. In order to implement a functioning, effective compliance program, somebody has to perform specific tasks. In many practices, a physician (or the physician in a solo practice) is named the compliance officer. In other practices, it is a senior staff member, often the office manager. And sometimes the compliance officer does not have any other duties in the organization, particularly in large practices. All of these models can work. However, where the compliance officer or manager also has other duties, it is critical that those duties do not cause a conflict of interest with the compliance duties. If the compliance officer or manager has other duties in the practice, care must be taken that the individual is permitted enough time to carry out his or her compliance duties. I have seen numerous practices where being the compliance officer takes a back seat to being the office manager or the head of accounting. Those are practices that often run into compliance problems on down the line.

Even more importantly than having the appropriate amount of time, the compliance officer or manager must be given the authority to implement required policies, procedures and practices. All too often, the compliance manager or office is given the responsibility for implementing a compliance program, but not the needed authority. Particularly in solo and small practices, it is not uncommon for the physician to name him or herself as chief compliance officer and then delegate the day-to-day compliance duties to another individual, while the physician remains chief compliance officer on paper. Regardless of whether the individual conducting the day-to-day compliance activities is the actual chief compliance officer or a subordinate performing delegated duties, the most important aspect here is that the compliance staffer not find himself or herself constantly overruled or second-guessed by the physician(s). Unfortunately, I have seen too many cases where a compliance officer is not given the required authority to do what needs to be done or where a physician or group of physicians discounts the sound advice given by the compliance officer.

A physician practice should also implement a compliance committee. A compliance committee has two main functions. First, the compliance committee serves as an oversight body. Second, the compliance committee can be a tremendous help in carrying out compliance duties. In a small practice, the compliance committee might end up consisting of most of the staff members. Conversely, in a large practice, the compliance committee often consists of senior physicians and staff members, such as the head of human resources, the chief financial officer and representatives of other key departments. The composition of the committee and the number of members is not as important as the committee members’ ability to provide oversight and additional resources and manpower in implementing a compliance program.

In terms of oversight, the compliance committee should meet periodically and receive reports from the compliance officer about the steps he or she has taken implement the compliance program.   Quarterly meetings are typical. The compliance officer or manager should chair the meetings. The compliance officer can and should report on implementation of policies and procedures, status of training, any incidents, payer audits and other related matters. The quarterly meetings should be documented and maintained among the practice’s key documents.

In terms of providing additional resources for implementing the compliance program, the compliance officer may have to depend on the representatives of other functions to actually perform or carry out specific duties. For example, the human resources department may be tasked with actually conducting background and sanctions screening or employee training, while the finance or accounting department may help with responding to payer audits or performing internal audits. In addition, other departments and functions can often smooth the way for the compliance officer to implement specific tasks, often by providing input into an initiative or suggesting more cost-effective means of achieving a goal. Finally, these other individuals can help a compliance officer by spreading the compliance message throughout an organization.

In summary, empowering a compliance officer and creating a functioning compliance committee are key to implementing an effective compliance program.

Next month: Basic policies and procedures

H-Kocher-photo-2-199x300Heidi Kocher, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

Liles Parker Attorney Achieves Recognition as a Certified Medical Compliance Officer – CMCO

March 17, 2013 by  
Filed under Firm News

Healthcare Lawyer(March 18, 2013): Liles Parker is pleased to announce that one of its Associate Attorneys, Ms. Lorraine Ater,  has completed the “Certified Medical Compliance Officer” course and passed the examination offered by Practice Management Institute (PMI), one of the oldest and most recognized medical education suppliers in the country.   Unlike other courses, PMI’s Compliance Officer certification course is believed to be the first comprehensive live course in the country focused on non-hospital medical office environments.   The curriculum has been rated as excellent and has also recently been approved for physician CEU credit. As Managing Partner David Parker stated:

“Liles Parker has always encouraged its staff to participate in continuing medical and legal education.  As a Certified Medical Compliance Officer, Lorraine is trained to understand our health care provider client’s business needs and better assist them when we conduct “GAP analyses” of a their medical office or clinic.  We are proud of Lorraine and look forward to working with her on our compliance projects for many years to come.”

Lorraine currently works as an Associate Attorney in Liles Parker’s Health Law Section.  She received her law degree from Lewis and Clark Law School in Portland, Oregon.  While in law school, she was selected to serve as an extern from her law school to work in the chambers of Senior Advocate Shyam Divan in New Delhi, India.  While there, she gained valuable experience conducting legal research and writing legal memoranda on matters before the Supreme Court of India.  She was awarded a Global Law Scholar Award by Lewis and Clark for her work.

Prior to law school, Lorraine attended Union College in Schenectady, New York, where she received a B.A. in Political Science, as well as a Minor in German (notably, Lorraine is fluent in German).  In her final year, she was the recipient of the Alvin F. Nitchman Prize, a prize awarded to the most promising senior who plans to attend law school.  Lorraine was selected from our staff candidates to take the PMI Compliance Certification course based on her growing expertise working with health care providers and suppliers around the country on regulatory and compliance-related projects.

Lorraine Rosado J.D., and Liles Parker’s other health care attorneys have extensive experience working with health care providers and suppliers around the country on a full range of compliance-related projects.  For a free consultation, please give Lorraine a call at: 1 (800) 475-1906.   

PMI’s Certified Medical Compliance Officer Program

January 27, 2011 by  
Filed under Firm News

Certified Medical Compliance(January 26, 2011):    Robert W. Liles, J.D. Managing Partner at Liles Parker, has been asked by Practice Management Institute (PMI) to develop and present its new “Certified Medical Compliance Officer” (CMCO) program.  This Compliance Officer Certification course will be held over a five day period — February 3-4 and March 2-4, 2011.

I.  What is the Focus of PMI’s “Certified Medical Compliance Officer” Program?

This Certification course is uniquely designed to address the needs of non-hospital health care providers.  It is specifically for current and soon-to-be Compliance Officers working in Physician Practices, Home Health Agencies, Hospice Companies, Durable Medical Equipment Companies, Physical Therapy Clinics, Third-Party Billing Companies and other small to mid-sized health care provider entities.  Unlike other Certification courses, this program has been developed to meet your organization’s compliance needs, not those of a hospital or large provider institution.   The Compliance Officer Certification course and exam will take place in Dallas at the Texas Health Presbyterian Hospital Dallas.

II.  Instructors of PMI’s Certified Medical Compliance Officer Program:

The primary speakers during the first two days will be Mr. Liles and D.K. Everitt.  Please join Mr. Liles and Mr. Everitt in Dallas as they present the course.  Mr. Liles represents health care providers across the nation. He focuses his practice on healthcare compliance, large Medicare overpayment defense and regulatory matters.  Before entering private practice, he served as Deputy Director for Legal Programs at the U.S. Department of Justice, Executive Office for United States Attorneys (EOUSA).  Additionally, while at EOUSA, he also served as the country’s first National Health Care Fraud Coordinator, responsible for working with the civil and criminal health care fraud coordinators in each of the U.S. Attorney’s Offices around the country.

Mr. Everitt is a nationally-recognized Healthcare Compliance Officer, whose work includes assessing hundreds of medical practices and facilities, implementing Corporate Integrity Agreements and OSHA compliance training.  He has authored several compliance books and is credited with the definitive guide on OHSA for medical practices.  Mr. Eveirtt serves as president of The Compliance Division, L.L.C.  He has spent the last 25 years developing and managing corporate compliance programs and shares his talents as an Adjunct Lecturer and Preceptor for Trinity University’s Health Care Administration Graduate Studies department. He has shared his knowledge with participants at several of PMI’s conferences. Mr. Everitt also serves on PMI’s Contributing Editor Board of Experts.

To enroll in this class, or if you have any questions, call PMI at 1-800-259-5562 between the hours of 8 a.m. and 5 p.m., Monday through Friday. Seating is limited and will be provided on a first come first served basis.

Robert Liles Healthcare AttorneyRobert W. Liles, J.D., M.B.A., M.S., represents health care providers around the country in connection with Medicare, Medicaid and private payor audits.  He also provides regulatory compliance guidance and advice to providers and suppliers that participate in federal and state health benefits programs. For a free consultation, call:  1 (800) 475-1906.